Summary Plan Descriptions

njjel

Is there such a thing out there as a generic SPD where we can plug in our own information?

System

For what product? If it's for your retirement plan, your provided might have the SPD. If it's for a P.O.P, that vendor should have it as well. I've never found a 'model' plan, but then it's been about 4 years since I looked.

SMace

We always get ours from our plan administrator. I know of no generic version. Contact a vendor and see if they'll help.

irenesmsaclaims

I'm assuming this is for a self-funded plan; otherwise, the carrier would provide the master contract and SPDs. These documents are very often proprietary; people are paid to write them for the group's particular specifications and intent. You may be able to buy a boiler-plate document, but it would require a great deal of modification in many areas, and you would want to be sure it is totally compliant and up to date with the law.

njjel

Our carrier provided our plan description but stated that it was only part of what an SPD should cover. this is for our health plans. I'm at a loss as to what else we need to do.

SMace

I think if they are not going to help you (which I find unbelievable and would drop them like a hot potato at my next opportunity) you need to contact an attorney and get them to help you. If you are self-funded it is your fiduciary duty to provide a document to protect your company.

njjel

no, we are no self-funded.

SMace

Do they administer your COBRA coverage?

njjel

No they do not.

SMace

I imagine that is what they are talking about. Do they include the COBRA info in your SPD?

njjel

Yes they do.

SMace

If HIPAA is in there I'm at a loss as to what you would need to add. You are fully insured, so it's their buttocks if something goes wrong with your plan. Did you ask them to specify what's missing?

njjel

Yes and I was advised that all they supply is the plan info that there is ERISA info and other info that should be included?????

SMace

I'm no ERISA expert, so maybe someone like irene can jump in, but in a fully insured product they are the plan administrator at it's their burden to insure the plan is ERISA compliant. Unless someone else can weigh in definitively, I would call an ERISA attorney. Then I would send them the bill.

irenesmsaclaims

I too find it odd that an insuror would not create SPDs (sometimes called certificates) for a fully-insured plan. It's a matter of duplicating the information in the master contract (plan document) and adding things such as employer information, plan sponsor, plan administrator, with addresses, phone numbers, etc. It must contain all of the compliance requirements of COBRA, HIPAA (Portability and Privacy), FMLA, USERRA, QMCSO and participants' rights under ERISA. I know that the most of the major carriers do this, but it is NOT a carrier obligation under ERISA, it is the employer's obligation. Is this a non-mainstream insurance company?

Actually, under ERISA, the employer is the plan administrator/sponsor, so I think a bill for attorney's fee would probably go unpaid by the insuror!! You need to make sure the carrier will not provide this this and ask why.